Healthcare Provider Details

I. General information

NPI: 1508236779
Provider Name (Legal Business Name): BRANDI STEWART OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N ASHLAND AVE
CHICAGO IL
60622-5149
US

IV. Provider business mailing address

2706 N MILWAUKEE AVE
CHICAGO IL
60647-1308
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-0407
  • Fax: 312-942-0741
Mailing address:
  • Phone: 773-862-5000
  • Fax: 773-862-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number046.012074
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012074
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: